Pediatric Coding Alert

Question: When a child comes in for a WIC (Women, Infants and Children) check and has weight and lab work done, but doesnt see the doctor, how should we bill? Can we charge for the form, the weight check and the labs?

Pennsylvania Subscriber

 
Answer: The best way to handle this is to pull the information from the chart if the child has been seen recently. If a child is getting formula, your practice should have seen him or her within the last few months. Do not bill for just filling out the form. Although there is a code for this (99080, special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form), Medicaid wont recognize it.
 
If the child needs a separate visit for the WIC check, and only the nurse sees the patient for the weight check and blood draw, code 99211 (office or other outpatient visit ... established patient). Use V78.0 (special screening for disorders of blood and blood-forming organs; iron deficiency anemia) or V78.1 ( other and unspecified deficiency anemia) as the diagnosis.
 
In many communities, special WIC clinics perform this service. Dietitians who provide nutrition counseling at the WIC clinics should report the new nutrition codes 97802-97804.